Announcement

Collapse
No announcement yet.

Steroid Induced Rosacea - Severe Flushing, Redness and Burning

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts
    zxc
    Junior Member

  • zxc
    replied
    Hi nat007,
    I've not been diagnosed with rosacea, I guess that's the conclusion I've come to. The first gp I saw said it was eczema, i don't believe it is, he prescribed antibiotics and steroid cream, made no difference. The second gp I saw, I said I thought it was rosacea, he prescribed metro gel, made no difference.
    I'm back on Monday to see my gp again. I will asked to be referred to a dermatologist, as I just think the gps, just don't have the knowledge to investigate the issues properly. They just seem to say "try this and see if it works" without any proper examination or investigation. My face does not burn, or cause discomfort, just always red.

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    Originally posted by zxc View Post
    Hi, could you tell me what anti flushing medication you use please.
    My face is either red all over, or bright red all over. It doesn't itch or burn or cause any discomfort at all.
    It's just bright red!
    Hi

    the anti flushing medication that helps me personally (and some other people on here as well) is clonidine, propranolol
    and I use an antihistamine sometimes, like in pollen season or when I eat foods high in histamine.

    There are also some antidepressants that can actually help to cut down on facial flushing and redness, but more as a side effect. I use mirtazapine, but all antidepressants come with more potential side effects than the 3 medications I mentioned first. Then there are antimalarials, which help some people with flushing as well. Only antihistamines can be bought over the counter however, the others are all prescription and should be prescribed by your doctor. Clonidine and propranolol can bring your blood pressure down, so the doctor is kind of important in this story, as he or she needs to keep a track of your blood pressure when you start them..

    Ok, you are lucky in a way I guess that you don't burn? Does your face not tingle or feel hot either when you are so red? Did you get a diagnosis of rosacea? There are other conditions that can cause your face to go red, for instance KPRF, lupus, Erythromelgia and many more.. Before you start any medication, it's best to get a right diagnosis first, but maybe you already had one?

    take care

    Leave a comment:

  • zxc
    Junior Member

  • zxc
    replied
    Hi, could you tell me what anti flushing medication you use please.
    My face is either red all over, or bright red all over. It doesn't itch or burn or cause any discomfort at all.
    It's just bright red!

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    Originally posted by ephemerality View Post
    i am always "amazed" at how little responsibility those doctors are held accountable! people who drive cars and accidently hit and hurt someone are always held accontable; then why not those f-cking doctors who prescribe steroid like napkin dispenser and those f-cking doctors who zap people with lasers without carefully consider the patients full history snd skin conditions but just want to "collect" more patients/laser sessions and make money!!! those doctors' crimes are way more severe than drivers who hurt people during accidents!!!


    how long did you wait between the steroid (hydrocortisone) cream and that ipl? do you mind of sharing the reason that you chose ipl instead of some pdl (eg vbeam, ktp, yag) initially? have you tried any pdl after that ipl then?

    Yeh it made me very angry and upset indeed, and I'm not alone. I know several people who had their skin worsened quite significantly by doctors and their IPL/laser machines. It makes most fuming that the doctors just say that their machines cannot be held responsible and that it must be rosacea's natural progression. They do walk off and forget about you, while you are left with a life in tatters. And worst of all; they had you sign a contract before it all started, so you have not a leg to stand on, if you want to stay within the legal side of the law.

    The steroid cream was used in 1999, the IPL in 2005. In between I first tried all sorts of natural treatment options, acupuncturists, herbalists, basic rosacea treatments like antibiotics and creams. Nothing worked. I was already on this forum back then and just rode the IPL hype that was going on already at the time. I got this doctors name from the forum too. I visited him in England a separate time, to ask for test patches but he dismissed that, said it wasn't necessary. I have regretted this bitterly.
    I understood at the time that IPL was 'best' for flushing and base redness. I don't have visible blood vessels, which was thought to be the thing to use laser for. Later those insights seem to have changed, I think the consensus here is now that for flushing the v-beam or some other ype of laser is actually more effective.

    I had test patches with pdl laser after 2005, first with my local dermatologist, then the late Dr. Crouch helped me a lot, doing all sorts of test patches for free; pdl, yag, also Lumenis One IPL. None of the lasers gave me any pale skin response. The Lumenis One did with certain triple layer settings, but when we did a full face treatment in 2006, it gave me a month long inflammation and redness all over my face. Took NSAID medication to calm things down and in the end, that IPL didn't help me but didn't make me worse either, so no drama that time, luckily. Crouch thought I am not a good candidate for laser nor IPL, as my skin is too reactive and sensitive and I have some light sensitivities too. Then in 2011 and 2012 I had part of my lower cheek test patched with v-beam perfecta, just to be sure that one could help me (Crouch didn't have that type of laser) but it showed no effect whatsoever, and I didn't dare to do a full face treatment as a result. That's the score. I am too afraid I'll make matters worse with either laser or IPL as it stands now.

    Leave a comment:

  • ephemerality
    Member

  • ephemerality
    replied
    i am always "amazed" at how little responsibility those doctors are held accountable! people who drive cars and accidently hit and hurt someone are always held accontable; then why not those f-cking doctors who prescribe steroid like napkin dispenser and those f-cking doctors who zap people with lasers without carefully consider the patients full history snd skin conditions but just want to "collect" more patients/laser sessions and make money!!! those doctors' crimes are way more severe than drivers who hurt people during accidents!!!


    how long did you wait between the steroid (hydrocortisone) cream and that ipl? do you mind of sharing the reason that you chose ipl instead of some pdl (eg vbeam, ktp, yag) initially? have you tried any pdl after that ipl then?


    Originally posted by nat007 View Post
    You might be right. I never fully understood what happened there and how I could go from no flushing to getting a flushed face most evenings or from a host of triggers.It might be indeed what you just wrote, that these steroids get to some people sooner than to others. The ****ty thing is; you can't turn it back, you can't 'undo' the few days of steroid cream use. I looked up teenage pictures lately to look for signs of early rosacea there and the only thing I found was a drunk night on holiday where I had some mild redness on the upper cheeks from the alcohol. Nothing I could notice unless I looked in a mirror, no obvious flush heat and burning. That all started right after the steroid use.

    Yeh I had an unhappy IPL experience. I have a lot of pictures on the blog, thnx for reading btw, and as those pictures show, I did have redness and flushing before the IPL. But mainly on my upper cheeks. On the apples of the cheeks so to speak. Not full face. And I could have pale skin too when the flush calmed down again. So no 24/7 constant redness. I didn't need a fan all the time either back then. But after that IPL I flushed and went (still go) red all over my cheeks, the entire cheek area, and chin and ears too. And a much deeper shade of red also, compared to before. So there has since been redness and flushing where there never used to be any, and I flush about 20 times more, like; a lot more and severe ever since. The year right after that IPL was the worst. Then I was given anti flushing medication.

    What the medication does for me, is to not have me flushed and beet red 24/7 anymore. I do get very red and flushed still, especially now in winter or in the heat of summer. But I can have lighter skin if not flushed and when I keep cool too now. I'm subtype 1 with a lot of crazy flushing, the redness comes with the flushing. It's not permanent in a way, as when I am all cooled up, I can look fairly pale. I just flush at the drop of a hat and go from scale 2 to 8 or 9, if you'd want to scale such a thing. Much more red now than before the IPL and on a much bigger skin area (everywhere that dr zapped me) than before.

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    Originally posted by ephemerality View Post
    i see. i still believe your condition was caused by steroid. the doctors' so-called "predisposition to rosacea" actually does not make any sense. think about this logically: if 100 people get affected by same amount of radiation, then 20 people get cancer, but the rest 80 don't. for those 20 cancer people, no doctor will say "hey, you get cancer because you are predisposed to cancer!" instead, it is natually accepted as that radiation caused those 20 people cancer! in terms of why the other 80 people who dont get cancer, doctors will say "they are healthier, stronger resistance to radiation!" one thing doctor won't say is "those 80 people are not predisposed to cancer". for those 80 people, it will take a lot more radiation to cause cancer in them. that is the only difference. same logic applies to steroid induced rosacea. some people get affected by even 1 time application of topical steroid, while some people display symptons only after many years of application. it only means some poeple have strong blood vessels resistant to steroid while some people have weak vessels to steroid.


    i read some of your other posts where you mentioned that you had a unsuccessful (bad) ipl experience. did you develop constant background redness before this ipl, or only after this ipl? when you mentioned that you use medications to keep your redness and flushing at bay, do you mean that your background redness is gone / you have your pale skin back when you are on medications?

    btw, i really like your blog. keep it up!

    You might be right. I never fully understood what happened there and how I could go from no flushing to getting a flushed face most evenings or from a host of triggers.It might be indeed what you just wrote, that these steroids get to some people sooner than to others. The ****ty thing is; you can't turn it back, you can't 'undo' the few days of steroid cream use. I looked up teenage pictures lately to look for signs of early rosacea there and the only thing I found was a drunk night on holiday where I had some mild redness on the upper cheeks from the alcohol. Nothing I could notice unless I looked in a mirror, no obvious flush heat and burning. That all started right after the steroid use.

    Yeh I had an unhappy IPL experience. I have a lot of pictures on the blog, thnx for reading btw, and as those pictures show, I did have redness and flushing before the IPL. But mainly on my upper cheeks. On the apples of the cheeks so to speak. Not full face. And I could have pale skin too when the flush calmed down again. So no 24/7 constant redness. I didn't need a fan all the time either back then. But after that IPL I flushed and went (still go) red all over my cheeks, the entire cheek area, and chin and ears too. And a much deeper shade of red also, compared to before. So there has since been redness and flushing where there never used to be any, and I flush about 20 times more, like; a lot more and severe ever since. The year right after that IPL was the worst. Then I was given anti flushing medication.

    What the medication does for me, is to not have me flushed and beet red 24/7 anymore. I do get very red and flushed still, especially now in winter or in the heat of summer. But I can have lighter skin if not flushed and when I keep cool too now. I'm subtype 1 with a lot of crazy flushing, the redness comes with the flushing. It's not permanent in a way, as when I am all cooled up, I can look fairly pale. I just flush at the drop of a hat and go from scale 2 to 8 or 9, if you'd want to scale such a thing. Much more red now than before the IPL and on a much bigger skin area (everywhere that dr zapped me) than before.
    nat007
    Senior Member
    Last edited by nat007; 21 January 2017, 12:29 AM.

    Leave a comment:

  • ephemerality
    Member

  • ephemerality
    replied
    i see. i still believe your condition was caused by steroid. the doctors' so-called "predisposition to rosacea" actually does not make any sense. think about this logically: if 100 people get affected by same amount of radiation, then 20 people get cancer, but the rest 80 don't. for those 20 cancer people, no doctor will say "hey, you get cancer because you are predisposed to cancer!" instead, it is natually accepted as that radiation caused those 20 people cancer! in terms of why the other 80 people who dont get cancer, doctors will say "they are healthier, stronger resistance to radiation!" one thing doctor won't say is "those 80 people are not predisposed to cancer". for those 80 people, it will take a lot more radiation to cause cancer in them. that is the only difference. same logic applies to steroid induced rosacea. some people get affected by even 1 time application of topical steroid, while some people display symptons only after many years of application. it only means some poeple have strong blood vessels resistant to steroid while some people have weak vessels to steroid.


    i read some of your other posts where you mentioned that you had a unsuccessful (bad) ipl experience. did you develop constant background redness before this ipl, or only after this ipl? when you mentioned that you use medications to keep your redness and flushing at bay, do you mean that your background redness is gone / you have your pale skin back when you are on medications?

    btw, i really like your blog. keep it up!


    Originally posted by nat007 View Post
    I don't think in my personal case that it caused me steroid induced rosacea, conflicting as this might sound. When you google images of that one, it usually shows symptoms more like subtype 2, with thickened inflamed red skin. You usually get that after prolonged use of steroid cream on the skin. My dermatologists said that they think the steroid cream somehow triggered my facial flushing and burning, triggered some predisposition for rosacea.
    I had always pale skin but after that steroid use (and the stress that I had at the time won't have helped either) I suddenly got flushing episodes, where my face would turn red and hot and this wave of heat came over my face. I never had that prior to the steroid use. But when the flush stopped, initially my skin would look normal. Now, 18 years later, I have a lot more background redness but I think that is just the natural progression of the rosacea, and all those years of flushing.

    Yes at the time my skin seemed to have a shiny veil over it, indeed, and more red.

    For strictly steroid induced rosacea, there seem to be patients who can get their skin back to relative normality after treatment. Antibiotics for instance, certain creams. For subtype 1 and flushing and burning, what I have, this hasn't proved helpful. I can mainly try to keep the flushing and redness at bay with anti flushing medication and trigger avoidance.

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    Originally posted by ephemerality View Post
    there are not many much useful info on interrnet about treatment/recovery of steroid induced rosacea. also, it seems like a lot discrepancies regarding whether "steroid induced rosacea" can be cured or not. some threads here say that it can be gone in 6 months. but, i notice that some people say that they are stll suffering from it even after many many years.

    did you develop constant background redness (looks like a painted veil --- very diffused) right after hydrocortisone? did you notice some kind of weird glistening/shine over all area you applied that steroid (but the glistenng is not from oiliness on the skin)?
    what did your derm say about recovery from constant redness caused by steroid?
    I don't think in my personal case that it caused me steroid induced rosacea, conflicting as this might sound. When you google images of that one, it usually shows symptoms more like subtype 2, with thickened inflamed red skin. You usually get that after prolonged use of steroid cream on the skin. My dermatologists said that they think the steroid cream somehow triggered my facial flushing and burning, triggered some predisposition for rosacea.
    I had always pale skin but after that steroid use (and the stress that I had at the time won't have helped either) I suddenly got flushing episodes, where my face would turn red and hot and this wave of heat came over my face. I never had that prior to the steroid use. But when the flush stopped, initially my skin would look normal. Now, 18 years later, I have a lot more background redness but I think that is just the natural progression of the rosacea, and all those years of flushing.

    Yes at the time my skin seemed to have a shiny veil over it, indeed, and more red.

    For strictly steroid induced rosacea, there seem to be patients who can get their skin back to relative normality after treatment. Antibiotics for instance, certain creams. For subtype 1 and flushing and burning, what I have, this hasn't proved helpful. I can mainly try to keep the flushing and redness at bay with anti flushing medication and trigger avoidance.

    Leave a comment:

  • Brady Barrows
    Senior Member

  • Brady Barrows
    replied
    Treatment for Steroid Rosacea

    I have gathered together these treatments and will add more when found:

    "Both the flashlamp-pumped long-pulse dye laser and the KTP laser may play a role in the treatment of facial and leg telangiectasias...Telangiectasias develop on the face secondary to genetic predisposition, chronic actinic damage, collagen vascular disease, topical steroid application, and disorders of vascular regulation including acne rosacea." Source


    1% pimecrolimus cream Source


    FK506 (tacrolimus) may control the increase in IL-1alpha with glucocorticoid in KCs, suggesting FK506 to suppress harmful effects of glucocorticoids such as steroid rosacea. Source


    Combination therapy of tetracyline and tacrolimus Source
    Please note:

    However, one report of using Tacrolimus resulted in a "proliferation of Demodex due to local immunosuppression." Source
    Caveat emptor! Another report concluded "Topical tacrolimus is becoming an important cause of RD [rosacea-like dermatitis] along with topical steroids." Source


    A combination of oral antibiotics and topical tacrolimus is the treatment of choice for steroid-induced rosacea. Source


    Treating Steroid Induced Rosacea, Linda Sy, MD Source


    Calendula cream for steroid induced rosacea by May2012


    Episofit A Source

    Leave a comment:

  • ephemerality
    Member

  • ephemerality
    replied
    there are not many much useful info on interrnet about treatment/recovery of steroid induced rosacea. also, it seems like a lot discrepancies regarding whether "steroid induced rosacea" can be cured or not. some threads here say that it can be gone in 6 months. but, i notice that some people say that they are stll suffering from it even after many many years.

    did you develop constant background redness (looks like a painted veil --- very diffused) right after hydrocortisone? did you notice some kind of weird glistening/shine over all area you applied that steroid (but the glistenng is not from oiliness on the skin)?
    what did your derm say about recovery from constant redness caused by steroid?


    Originally posted by nat007 View Post
    I agree with you. I only used a hydrocortisone cream for around 3 or 4 days in the area around my mouth and nose, a bit on a cheek, and developed rosacea, flushing, redness and burning seemingly overnight from it. It was ridiculous really. You put that very well. The problem is that for some people on here even, with existing rosacea, short term steroid use doesn't hurt their rosacea. You just don't know beforehand if you'll be fine with it, or if you are one of the unlucky few who have their rosacea worsened by it. But my derm always says; it's Russian roulette and if you are a heavy flusher, I'd not take the risk. He warns me against any type of steroid use, including steroid nose spray and eye drops.

    The worst part is that the steroid use is often not even strictly necessary.. I had some mild eczema and it really didn't require a steroid cream, but I never had skin problems prior and never thought a short period of use could pose such risks. I feel that doctors, both dermatologists and GP's, need to be aware of the fact that steroids can trigger rosacea in those with a higher risk for it, like a tendency to blush, to sunburn and people with pale skin that easily goes red. But absolutely, it's an easy fix for all according to quite a lot of skin doctors, and it's a money making thing for pharma, as it suppresses symptoms and makes the skin addicted to some degree to this cream (weaning off gives often rebound symptoms).
    And if it goes wrong, then most will say they never saw this happen before and that they see no correlation. 'Next!'

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    Originally posted by ephemerality View Post
    steroid induced rosacea does not requires long term usage of steroid. for some people, even 1 time application can do all the damage. don't believe the standard BS thrown out there by those "medical professionals". everyone's body is different;everyone's blood vessel flexibility/resilience/stability is different. maybe, it is true, for majority people, it takes months of steroid to develop rosacea red face; and there are people who never develop red face no matter how long they keep using steroid. however, for a small number of people, the full steroid damage only requires very short times (days, not even weeks).

    there is no possibility to persuade those medical professionals to admit/believe the severe danger from steroid. biggest tools (pretty much the only tools) western medecines have are "antibiotic" and "steroid". by playing with those 2 things, pharma comps and docs have been able to make tons of shxt loads of money. especially those dermatologies, without steroid cream, half of them would show up with dumbface and lose job right there, because they really have and know nothing else to offer patients.

    it is all about money! 1 unlimited supply in the world for derms (and docs and pharma comps) are people. they can keep making money, have their "respectful careers", and pile up assets for their children, as long as general population keep believing their fooling with the notion that "short-term steroid use does not cause problem" and "steroid usage under direction of your doctors is safe".

    what consequence is there to them when they ruin our faces!!! they will just get new patients and keep doing the same thing, and anyway, some people will be fine, and some will be ruined!

    I agree with you. I only used a hydrocortisone cream for around 3 or 4 days in the area around my mouth and nose, a bit on a cheek, and developed rosacea, flushing, redness and burning seemingly overnight from it. It was ridiculous really. You put that very well. The problem is that for some people on here even, with existing rosacea, short term steroid use doesn't hurt their rosacea. You just don't know beforehand if you'll be fine with it, or if you are one of the unlucky few who have their rosacea worsened by it. But my derm always says; it's Russian roulette and if you are a heavy flusher, I'd not take the risk. He warns me against any type of steroid use, including steroid nose spray and eye drops.

    The worst part is that the steroid use is often not even strictly necessary.. I had some mild eczema and it really didn't require a steroid cream, but I never had skin problems prior and never thought a short period of use could pose such risks. I feel that doctors, both dermatologists and GP's, need to be aware of the fact that steroids can trigger rosacea in those with a higher risk for it, like a tendency to blush, to sunburn and people with pale skin that easily goes red. But absolutely, it's an easy fix for all according to quite a lot of skin doctors, and it's a money making thing for pharma, as it suppresses symptoms and makes the skin addicted to some degree to this cream (weaning off gives often rebound symptoms).
    And if it goes wrong, then most will say they never saw this happen before and that they see no correlation. 'Next!'

    Leave a comment:

  • ephemerality
    Member

  • ephemerality
    replied
    steroid induced rosacea

    Originally posted by nat007 View Post
    *I think it might have triggered the rosacea for me.

    Got some slack from someone over this, but what I tried to say is that it seems in my case the steroid cream triggered lingering underlying rosacea. Normally a short course of steroid cream doesn't give steroid induced rosacea. I asked my doctors at the time how all of this could have started. Been told that they suspect that I had the (dormant) rosacea gene so to speak, already. The tendency to blush, very pale skin, and that sometimes something has to trigger rosacea to erupt. For one person that can be stress, for another a steroid cream potentially, for another it is hormonal change or something else.

    steroid induced rosacea does not requires long term usage of steroid. for some people, even 1 time application can do all the damage. don't believe the standard BS thrown out there by those "medical professionals". everyone's body is different;everyone's blood vessel flexibility/resilience/stability is different. maybe, it is true, for majority people, it takes months of steroid to develop rosacea red face; and there are people who never develop red face no matter how long they keep using steroid. however, for a small number of people, the full steroid damage only requires very short times (days, not even weeks).

    there is no possibility to persuade those medical professionals to admit/believe the severe danger from steroid. biggest tools (pretty much the only tools) western medecines have are "antibiotic" and "steroid". by playing with those 2 things, pharma comps and docs have been able to make tons of shxt loads of money. especially those dermatologies, without steroid cream, half of them would show up with dumbface and lose job right there, because they really have and know nothing else to offer patients.

    it is all about money! 1 unlimited supply in the world for derms (and docs and pharma comps) are people. they can keep making money, have their "respectful careers", and pile up assets for their children, as long as general population keep believing their fooling with the notion that "short-term steroid use does not cause problem" and "steroid usage under direction of your doctors is safe".

    what consequence is there to them when they ruin our faces!!! they will just get new patients and keep doing the same thing, and anyway, some people will be fine, and some will be ruined!

    Leave a comment:

  • hg24
    Senior Member

  • hg24
    replied
    Originally posted by daniperuci View Post
    Hi

    Sorry take so long to reply.

    Lately I'm avoiding the fan since my skin has calmed about 30% but it is still so depressing to be suffering from the steroid usage. In the meantime I was put in three antibiotics with little to no improvements so my dermatologist recommended low dose accutane - 10mg every other day or third day. Did you tried accutane for steroid rosacea? For the burning he gave me clonidine and propalonol with helps a bit but what is driving me crazy lately is that the side of my face I sleep on wakes up almost purple and I'm scared I'll have permanent damage.
    Hi, I sleep on my back propped up with a few pillows - because when I slept on my side, my face flushed terribly. It's not my preference and it took me a little bit of time to get used to it. But it stopped the sleep volcano I was getting. I miss sleeping on my side. But it's definitely been worth it to become a back sleeper. Back sleepers also develop less wrinkles - so there's that.

    Sent from my Classic using Tapatalk

    Leave a comment:

  • daniperuci
    Junior Member

  • daniperuci
    replied
    Originally posted by nat007 View Post
    Sorry to read about your ordeal! The burning and flushing is ghastly, isn't it?
    I had the same happening to myself but already back in 1999 and after only short term use of steroid cream. I think it might have triggered the rosacea for me.

    I use this medication and it has helped me to cut down on the flushing and burning: clonidine, propranolol, mirtazapine and if needed an antihistamine (Xyzal).

    All the antibiotics I used, never helped me with the skin redness/burning/flushing. But some do find them beneficial, especially because they can lower inflammation. But for flushing and burning, there are generally speaking better treatments and medication out there.

    Hope this helps! Have you tried using a ventilator on a good distance at night? To stay cooler?

    Take care!

    Hi

    Sorry take so long to reply.

    Lately I'm avoiding the fan since my skin has calmed about 30% but it is still so depressing to be suffering from the steroid usage. In the meantime I was put in three antibiotics with little to no improvements so my dermatologist recommended low dose accutane - 10mg every other day or third day. Did you tried accutane for steroid rosacea? For the burning he gave me clonidine and propalonol with helps a bit but what is driving me crazy lately is that the side of my face I sleep on wakes up almost purple and I'm scared I'll have permanent damage.

    Leave a comment:

  • nat007
    Senior Member

  • nat007
    replied
    You might be fine with the mometasone Aafdup. If you're not flushing a lot from it, and you don't use it long term, you're most likely tolerating it fine. It's effective at reducing inflammation. Just, my derms are so vocal about not using steroids in any shape or form, I pass that warning on here, but many people might tolerate steroids short term. It's just a caution thing.
    For seb derm treatment long term, maybe the ketoconazole cream itself is enough though? I don't have experience with the keto shampoo bit assume you wash it off, whereas the cream just works all night if you put it on before bed. It might not be enough for severe seb derm, not sure, it does the job for mine though.

    Leave a comment:

Working...
X